Impact of Micro Health Insurancecase Study of Sampoorna Suraksha Programme in Karnataka

Abstract

Micro health insurance (MHI) is a pivotal and innovative health financing mechanism that mitigates iatrogenic poverty thereby providing financial protection to the informal sector. However, the limited evidence from India does raise research questions regarding the effectiveness of MHI schemes in achieving these objectives. Thus, this thesis focuses on this area of research gap in MHI to evaluate its impact on (i) financial protection, (ii) social inclusion, (iii) resource mobilization, and (iv) the role of scheme characteristics on its performance. Sampoorna Suraksha Programme (SSP), a MHI scheme in Karnataka was chosen to study the research gap on impact and performance using a descriptive survey research methodology using self-administered validated questionnaire. Multi-stage, clustering design with random selection procedures was adopted to collect quantitative data from 416 insured, 366 newly insured and 364 uninsured self-help group (SHG) households of Dakshina Kannada, Uttara Kannada and Gadag districts in Karnataka State. Qualitative data was collected using in-depth interviews with network hospital staff, field staff and administrators of SSP, and focus group discussion with the members of SHG households. The results on financial protection indicated a lower out of pocket expenditure and catastrophic health expenditure, higher utilisation of inpatient services, desired health-seeking behaviour and decreased borrowing for the insured households. There was no impact on access to care and social inclusion in enrolment. On the contrary, the inadequate resource mobilization evident from the study resulting from high claims ratio and lower premium collection would pose a threat to the long-term financial sustainability of SSP. The study indentified certain design features that influenced the outcome of SSP. The findings of this study provide adequate evidence to substantiate the effectiveness and positive impact of SSP on financial protection and MHI certainly is advocated as a financing alternative to mitigate iatrogenic poverty.